Common Reasons For Denial Of Workers’ Compensation Claims

Common Reasons For Denial Of Workers’ Compensation Claims

Workers’ compensation laws provide an avenue for people who are injured on the job to receive compensation for their injuries without having to sue an employer. It is important to keep in mind that not all workers’ compensation claims are approved and this may leave the worker injured and uncompensated. When a person suffers an injury performing job-related tasks, they typically file a claim. Employers conduct an investigation before agreeing to pay out benefits and not all claims are compensable. If an employer believes that the claim is invalid they can deny the claim. Some of the common defenses that an employer may raise are:

Inadequate Insurance Coverage

Workers’ compensation coverage does not cover every worker, for example, independent contractors are generally exempt from coverage. In the same vein certain domestic employees, agricultural workers or individuals covered under different policies may be exempt from coverage as well. Although this does not absolve an employer from their liability for injuries, it is often adequate grounds for the workers’ compensation claim to be denied.

Failure to Provide Timely Notice

It is mandatory for injured workers to provide notice to their employer when they suffer a work-related injury or develop an illness related to work. State laws establish the deadlines by which the employee must provide notice which could be 30 days, 45 days or 90 days depending on statutory requirements in that particular state. Some states require notice in as little as four days. Failing to provide timely notice of the illness enables an employer to deny the claim.

Statute of Limitations

An employer can deny a workers’ compensation claim if the statute of limitations has passed. The time limit in which the injured employee must bring forth a claim is called the statute of limitations. Once it has elapsed, the employee can no longer pursue the claim. There

Disputing Cause of Injury

Workers’ compensation coverage specifically provides benefits for employment related injuries and ailments. If an employer alleges that the employee’s injury was not caused by work, then the cause has to be determined before the claim can be resolved. Incidents such as a heart attack at work is generally not covered by worker’s compensation. Oftentimes, independent medical examinations are used to determine the actual cause of the injury.

Responsibility of Employee In Causing The Injury

Workers’ compensation benefits are generally only for accidents. They may cover negligent actions of coworkers but not intentional actions. Workers’ compensation is also not available for any self-inflicted injuries including work injuries intentionally caused in order to file a fraudulent claim.

Willful Negligence

Willful negligence of the claimant can be a reason for denial of the claim. For example, if someone gets intoxicated and violates safety rules, the employer can use these actions as a defense to the claim.

Not Seeking Timely Medical Treatment

The claimant must seek medical treatment in order to receive workers’ compensation benefits. An employer may require the injured employee to receive an independent medical examination from a doctor of their choosing if state law provides for it. Failing to attend is grounds for an employer to deny the claim.

An injured worker may file an appeal if his or her workers’ compensation claim is denied and in order to do so they must retain the services of a competent workers’ compensation attorney.

California Workers Compensation Lawyers , APC - Long Beach

295 Redondo Ave, Suite 201

Long Beach, CA 90803


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